High Deductible Health Plan Enrollment and Billing Portal Update

December 2014

Presentation Overview

• Eligibility Reminders

• Administration Information

• HDHP Benefit Overview

• Employee/Employer Rates

• Enrollment and Billing Portal Overview

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ACA Requirements – Coverage of Full-time Employees

Shared Employer Responsibility Provisions

• To avoid tax penalties under section 4980H of the Internal

Revenue Code large employers must offer health coverage

that is affordable and at least “minimal value” to all full-time

employees.

• Employees are considered full-time, and thus required to be

offered employer-sponsored health care, if they are

reasonably expected to work 30 hours per week.

• The requirement extends health benefit eligibility to non-

permanent full-time employees, who traditionally have not

been eligible for coverage under the State Health Plan.

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ACA Requirements – Eligibility Determination

• Employing units are responsible for determining whether or

not an employee is full-time.

• Employers have flexibility in determining an employee’s

status through a safe harbor that allows the employer to

select “measurement” and “stability” periods for determining

eligibility and offering coverage. If the safe harbor is not

used then employee status is determined every month.

• The State Health Plan cannot provide legal advice or

require employing units to adopt uniform measurement

periods for determining eligibility.

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Legislation & Statutory Requirements – Alternative Benefit

• Section 35.16 of SL 2014-100 (SB 744 Appropriations Act)

establishes a new health benefit eligibility category for full-

time employees not otherwise covered by the Plan (e.g. non-

permanent full-time employees) to comply with the

Affordable Care Act (ACA).

• G.S. 135-48.40(e) requires the Treasurer and Board of

Trustees to offer a health benefit coverage option for these

“newly eligible” employees that provides minimum essential

coverage at no greater than the ACA “Bronze” level and that

minimizes the employer contribution in an administratively

feasible manner.

• The State Health Plan established a high deductible health

plan available January 1, 2015 to meet this requirement.

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High Deductible Health Plan Option (HDHP)

Monthly Contributions: Employer = $117.62, Employee = $92.38

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Benefit Design Individual Coverage Family Coverage

Deductible $5,000 $10,000

Out-of-Pocket Maximum $6,450 $12,900

Coinsurance 50% 50%

ACA Preventive Medical Covered at 100% in-network

ACA Preventive Pharmacy Covered at 100% in-network

• Non-network benefits will be paid at 40%.

• The non-network deductible and out-of-pocket maximum will be 2 times

the in-network amounts.

Meets ACA minimum value standard

Eligible for a Health Savings Account (HSA), which will allow the employee to

make 2015 tax-exempt contributions of up to $3,350 ($6,650 for family

coverage) to an account that can be used to pay eligible medical expenses

Legislation & Statutory Requirements – Retiree Eligibility

• Section 35.16A of SL 2014-100 (SB 744 Appropriations Act) requires employing units to cover re-hired State retirees as active employees, if they are determined to meet definition of full-time employee.

• G.S. 135-48.41(j) specifies that during the time of their full-time employment, re-hired State retirees are not eligible for retiree health benefit coverage.

• This provision is consistent with prior law requiring employing units to cover re-hired retirees employed in permanent positions on a recurring basis and working 30 or more hours per week for nine or more months in a calendar year.

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Retiree Termination Process

• If a re-hired retiree meets the eligibility requirements,

employing units must offer the retiree coverage.

• While the retiree is not required to enroll in the HDHP, the

retiree is no longer eligible for the State Health Plan retiree

group coverage under the Retirement Systems as

required by state law.

• Therefore, the Plan will terminate the retiree from the

State Health Plan retiree group coverage under the

Retirement Systems.

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Retiree Termination Process

• To document the offer, you must update the Enrollment and Billing

portal with the retiree's information and notify the Plan.

• To notify the Plan, HBRs will need to complete the Retiree

Termination of Coverage Form and submit it to

HBRInquiries@nctreasurer.com.

• Once the form is received, the Plan will terminate the member and

send a letter to the retiree to confirm his or her termination.

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Retiree Re-enrollment Process

• At the point in which a retiree is no longer eligible for the

HDHP and are enrolled in the HDHP, they will be offered

COBRA coverage.

• Loss of eligibility is a qualifying life event under the State

Health Plan enrollment rules and retirees will have 30

days to re-enroll in their State Health Plan coverage under

the Retirement Systems.

• If they fail to re-enroll within the 30 days, they will be

unable to come back on the Plan until the next enrollment

period.

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• Members in this plan will have access to the MedCost PPO Provider Network

for medical services.

• Go to Medcost.com and click “Find a Provider” and select “MedCost/MedCost

ULTRA”

• The Pharmacy benefit will be managed by Express Scripts and will use

Express Scripts’ 2015 National Preferred Formulary.

• Members will be sent a monthly bill for their premium, which will be sent by

COBRAGuard, the Plan’s direct billing administrator.

• Eligible members will not use eEnroll to enroll in this plan. HBRs will have to

load eligible members into the Enrollment and Billing portal provided by

COBRAGuard.

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Administration Information

Monthly Premium Rates for High Deductible Health Plan (HDHP)

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Coverage Type

Employer Share

Employee Monthly

Premium

Dependent

Monthly Premium

Total Monthly

Employee Premium

Employee-only $117.62 $92.38 N/A $92.38

Employee + Child(ren) $117.62 $92.38 $169.78 $262.16

Employee + Spouse $117.62 $92.38 $376.56 $468.94

Employee + Family $117.62 $92.38 $470.56 $562.94

Open Enrollment Guide

• HBRs were be sent a pdf of the Enrollment Guide for eligible members.

• HBRs are responsible for sending the guide to eligible members.

• The guide will not include enrollment dates, so you will need to promote

when your employing unit will be hosting Open Enrollment for this plan.

• The State Health Plan’s website has one page dedicated to this plan in

which the following materials are available.

• To access this information, employees will need to visit www.shpnc.org

and click High Deductible Health Plan.

• ACA Preventive Services List

• HDHP ACA Preventive Medication List

• 2015 Express Scripts’ National Preferred Formulary

(preferred drug list)

• Benefit Booklet

• HDHP Summary

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Enrollment and Billing Portal

HBR Administration Site

• ncshp.hr.hrissuite.com

• If multiple locations are available

the HBR will need to select the

needed location.

• hbrsupport@cobraguard.net

• 1-855-552-6272 HBR Support line

• 7 AM – 5 PM CST Mon - Fri

Enrollment and Billing Portal

• Requests submitted for approval by the administrator will show on this screen once they have been approved.

Enrollment and Billing Portal

• Requests that have not yet been approved will show on the “Active Requests” tab.

Enrollment and Billing Portal

• Search function to locate a specific employee. Employee ID and Medicare Number will be removed from the search options.

Enrollment and Billing Portal

Main screen showing employee info. The HBR may upload supporting documentation on this screen. If a newly eligible dependent needs to be added please select “Add Family Member” and input the dependent’s information.

Enrollment and Billing Portal

The Employment tab shows the selected employee’s employment status

(active or COBRA), start date, end date and department.

Enrollment and Billing Portal

The Benefits tab will show active benefits the selected employee is enrolled in, once elections are made. If dependents need to be added to benefits due to a Qualifying Event please select “Edit Benefits” to process the request.

Enrollment and Billing Portal

The HBR will review the supporting QE documentation provided by the employee, upload the documentation and submit the request to add the dependent(s).

Enrollment and Billing Portal

Enrollment and Billing Portal

Enrollment and Billing Portal

Once the dependent’s information has been entered and the needed QE documentation is attached to the request the new dependent will show on the “Member & Family” tab.

Enrollment and Billing Portal

To manually add an employee select “Create Member” and enter the requested information.

Enrollment and Billing Portal

Enrollment and Billing Portal

The “Upload File” option will be added to the menu below the “Create Member” option.

Enrollment and Billing Portal

The “Report” function pulls an Excel file showing all active employees and dependents (if selected) enrolled in benefits as of a specific date.

Enrollment and Billing Portal

Enrollment and Billing Portal

If dependents are to be included, “Include Dependents” would be selected.

HDHP Employer and Member Billing

• Invoices by department will be included on the portal.

• Member invoices will be integrated on the member portal (shphdhp.com)

• Invoices are generated on the 10th of each month.

• Invoices are viewable online under the Invoices Menu Option.

• Once an invoice is opened in the system, it will show two options to pay the bill:

• Mail a check to the lockbox

• Click to pay online via ACH

• Once payment is received the invoice will be satisfied. The satisfied invoice will be viewable under the Invoice Tab.

• Billing reports are included in the system.

• If the member payment is not received by the end of the grace period the member will be terminated and the employer portion will be refunded on the next invoice.

HBR Billing

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Sample Employer Group Monthly Billing Statement

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HBR Monthly Billing

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Any outstanding bills will show under Open Transactions

HBR Monthly Billing

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Please make note of the Billing PIN # provided on the screen. You

will be required to enter this information on the Bank of America

website. The PIN # will change with each payment and may not be

preset by your department.

HBR Monthly Billing

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When

paying via

ACH

payment

the entire

amount

due must

be paid

HBR Monthly Billing

• To pay via physical check please send to:

North Carolina State Health Plan

ATTN: HDHP Payments

PO Box 505303

St. Louis, MO 63150

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www.shpnc.org

www.nctreasurer.com

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Thank you!

Additional Resources Available

www.shpnc.org click HBR